BILL ANALYSIS Ó
AB 989
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Date of Hearing: April 5, 2011
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall Jr., Chair
AB 989 (Mitchell) - As Amended: March 21, 2011
SUBJECT : Mental health: children's services
SUMMARY : Requires counties to include transition age foster
youth in programs addressing the mental health needs of
transition age youth in their three-year plans for funding from
the Mental Health Services Act (MHSA).
EXISTING LAW :
1)Establishes the MHSA, enacted by voter-approved Proposition 63
in 2004 to provide funds to counties for the expansion of
preventive and innovative programs and integrated service
plans to address the mental health needs of children, adults
and seniors through a 1% income tax on personal income above
$1 million.
2)Requires each county mental health program to submit a
three-year plan detailing the county's proposed MHSA-related
programs and activities to include all of the following in
accordance with MHSA priorities:
a) A program for prevention and early intervention.
b) A program for services to children, unless the county
provides substantial evidence that it is not feasible to
establish a wraparound program in that county.
c) A program for services to adults and seniors.
d) A program for innovations.
e) A program for technology and facilities needed to
provide services, including, if the proposal is for a
restrictive setting, a demonstration that the needs of the
population to be served cannot be met in a less restrictive
or more integrated setting.
f) An identification of personnel shortages resulting from
execution of the programs outlined above, and the required
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assistance from education and training programs established
pursuant to the MHSA.
g) A prudent reserve to ensure the county mental health
program will continue to serve children, adults and seniors
during years when the revenues for the Mental Health
Services Fund are below recent averages due to changes in
the state population and the California Consumer Price
Index.
3)Requires the programs outlined in b and c above, related to
services for children, adults and seniors, to include services
to address the mental health needs of transition age youth
ages 16 to 25.
4)Expresses the intent of the Legislature to ensure continued
oversight and accountability of the MHSA and for the state, in
consultation with the Mental Health Services Oversight and
Accountability Commission (Commission) to establish a more
effective means of ensuring county compliance with the MHSA.
5)Requires each county mental health program's prevention and
early intervention program to emphasize strategies to reduce
the negative outcomes that may result from untreated mental
illness, as follows: suicide, incarcerations, school failure
or dropout, unemployment, prolonged suffering, homelessness,
and removal of children from their homes.
6)Specifies that the MHSA may only be amended by a two-thirds
vote of both houses of the Legislature and only as long as the
amendment is consistent with and furthers the intent of the
MHSA. Permits provisions clarifying the procedures and terms
of the MHSA to be added by majority vote.
7)Establishes, under federal law, the Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) Program to provide
physical and mental health services to Medicaid (Medi-Cal in
California) beneficiaries under the age of 21, including
current and former foster youth.
FISCAL EFFECT : Unknown
COMMENTS :
MHSA: In November 2004, voters passed MHSA or Proposition 63
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which required each county mental health department to prepare
and submit a three-year plan to the Department of Mental Health
(DMH) that was required to be updated each year and approved by
DMH after review and comment by the Commission. In their
three-year plans, counties are required to include a list of all
programs for which MHSA funding is being requested that
identifies how the funds will be spent and which populations
will be served.
However, the 2011-2012 Budget MHSA trailer bill, AB 100
(Committee on Budget), Chapter 5, Statutes of 2011, passed and
signed into law with an urgency clause to become effective
immediately upon enactment, modified MHSA oversight and
reporting requirements. Pursuant to AB 100, counties are no
longer required to submit annual updates to the three-year plan,
and plans are no longer subject to review by the Commission and
the approval of DMH. AB 100 also temporarily diverts $861
million in MHSA funds to programs otherwise supported by the
general fund, including Medi-Cal Specialty Mental Health Managed
Care Programs, EPSDT, and special education programs, for budget
year 2011-2012 only due to the state's fiscal crisis.
Mental health needs of transition age foster youth:
Approximately 4,500 foster youth age out of California's foster
care system every year at age 18. Research shows that outcomes
for these youth are far worse than those of their non-foster
peers who can often rely on assistance from their parents and
families for financial and emotional support. Transition age
foster youth face daunting odds once they "age out" of care and
are forced to assume all the responsibilities of being an adult,
often with inadequate planning and preparation for this
transition to adulthood. In fact, it is well-documented that,
when compared to their peers, transition age foster youth face
higher rates of incarceration, struggle to achieve financial
independence, experience high rates of homelessness, are less
likely to earn a high school diploma and attend college, and are
more likely to experience mental illness and untreated medical
issues due to lack of access to health care. An often cited
Casey Family Foundation study found that former foster youth
experience post-traumatic stress disorder (PTSD) at levels five
times that of the general population - a level which exceeds
even that among war veterans.
Need for this bill: According to the author, transition age
foster youth between the ages of 16 and 25 suffer among the
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worst rates of mental illness of any population as a result of
being uniformly abused and neglected by their parents, separated
from their siblings and grandparents, shuffled from placement to
placement, and kicked to the streets to fend for themselves when
they turn 18 and age out of the system. The author notes that
while the MHSA directly references the need to fund programs
that ensure that transition age youth (TAY) ages 16-25 achieve
self-sufficiency successfully, transition age foster youth are a
subgroup of this population that warrants special treatment and
elevated priority because they have uniquely acute mental health
needs that separate them from their TAY peers.
In January 2010, the Children's Advocacy Institute (CAI), the
sponsor of this bill, released a report that reviewed whether
MHSA-funded programs are reaching the state's transition age
foster youth. The report notes that foster youth transitioning
out of care have unique standing among priority populations for
programs funded by MHSA for numerous reasons. Specifically, the
report finds that transition age foster youth lack parental
support to help them cope with their mental health challenges
and, as children of the State, they are owed a special moral as
well as legal obligation to ensure their emotional and mental
wellness; they are cloaked by a confidential child welfare
system that makes it difficult for them to provide input to
county officials when making local planning decisions; they
experience mental illnesses, including suicidal behavior, major
depressive disorder, and post-traumatic stress disorder, at
significantly higher rates than the general population; and,
lastly, they lack the traditional roots provided by a family
structure so they tend to move between counties as they exit the
foster care system and are unable to take advantage of county
programs that do not accept out-of-county youth.
The CAI report graded California counties on the extent to which
they have been using MHSA funds to benefit transition age foster
youth. The report found that most counties acknowledge these
youth as highly at risk of developing mental illnesses and
appropriately identify them as a priority population for
MHSA-funded services but only as one of several other at-risk
TAY populations being served by their programs. Other TAY
populations include prisoners returning to society or TAY
exiting the juvenile justice system. CAI assessed, 26 counties
with a "failing" grade for having MHSA programs that are not
effectively reaching roughly four out of every five of the
state's transition age foster youth. Another seven counties,
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home to approximately 15% of these youth, received a D grade,
meaning that these youth live in counties with MHSA programs
that lack adequate capacity to meet their needs and must compete
with priority populations for these limited services.
In February 2010, the California Mental Health Directors
Association (CMHDA), which represents county mental health
departments, issued a statement in response to the report,
contending that while the report provides well-founded reasons
why mental health services are needed for transition age foster
youth, it ignores the important progress California counties
have made in serving the needs of local communities, including
transition age foster youth, through MHSA and other funding
sources. CMHDA notes that MHSA requires counties to exhaust
other resources before expending MHSA funds, and specifically
requires that funds be used to serve individuals not covered (or
not fully covered) by private insurance or public mental health.
CMHDA points out that many transition age foster youth are
served by Medi-Cal and EPSDT services until age 21 and, once
these entitlement services are exhausted, counties can use MHSA
funds to fill in the gaps.
Support: CAI, the bill's sponsor, writes in support that,
because transition age foster youth have unique experiences and
unique characteristics as a group, any program attempting to
address their mental health and well-being must be equally
unique, and specifically tailored to meet these specific issues.
CAI states that this bill simply clarifies for local MHSA
authorities that funding for programs for transition age youth
includes programs that address the more acute and desperate
needs of subcategory of transition age foster youth:
ÝThis bill] does not force the county to fund
anything. It does not set aside funding. It does not
prioritize funding. It in no way seeks to alter,
direct, or control county Prop. 63 decision-making on
how funds ultimately ought to be spent.
ÝThis bill] simply?clarifies for local Prop. 63
authorities that when weighing whether to fund
"transition age youth," that larger category of youth
includes the smaller category of transition age foster
youth, also indisputably worthy of at least being
talked about.
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The California Alliance of Child and Family Services adds that
the inclusion of transitional foster youth in county MHSA plans
will ensure that this fragile population is better able to
access mental health services to address their needs.
Support if amended: CMHDA supports this bill if it is amended
to make it permissive, rather than mandatory, for each county's
MHSA plan to include transition age foster youth in their
required programs for services for TAY. CMHDA is concerned that
specifically requiring the inclusion of transition age foster
youth in county MHSA plans will create a preference for this
population over other TAY populations and flout the local
community-driven process of identifying and prioritizing local
needs and populations.
Related Legislation:
AB 181 (Portantino) sets forth rights for foster youth relating
to mental health services and directs the Office of the State
Foster Care Ombudsperson to consult with specified entities to
develop standardized materials explaining these rights and to
distribute the information to foster youth by July 1, 2012. AB
181 is scheduled for a hearing in the Assembly Human Services
Committee on April 26, 2011.
AB 100 (Committee on Budget) Chapter 5, Statutes of 2011 makes
necessary changes to enact the Budget Bill for fiscal year
2011-12 related to MHSA and, among other things, eliminates the
requirement for DMH and the Commission to review and approve
county plans and for counties to perform annual updates.
DOUBLE-REFERRAL: This bill has been double-referred. This bill
passed out of Assembly Health Committee (15-1) on March 39,
2011.
REGISTERED SUPPORT / OPPOSITION :
Support
Children's Advocacy Institute
California Alliance of Child and Family Services
California Mental Health Director's Association
California Youth Connection
NAMI California
AB 989
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Opposition
None on file.
Analysis Prepared by : Michelle Doty Cabrera / HUM. S. / (916)
319-2089